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TREASURY  DEPARTMENT 
UNITED  STATES  COAST  GUARD 


DIRECTIONS 


FOR 


RESTORING  THE 
APPARENTLY  DROWNED 

FOR  SAVING  DROWNING  PERSONS 
BY  SWIMMING  TO  THEIR  RELIEF 


-AND  FOR  THE- 


TREATMENT    OF    FROSTBITES 

AS  PRACTICED  IN  THE 

UNITED  STATES  COAST  GUARD 


OF  THE 
NIVEKSITY     * 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1916 


TREASURY  DEPARTMENT 
UNITED  STATES  COAST  GUARD 


DIRECTIONS 

FOR 

RESTORING  THE 
APPARENTLY  DROWNED 

FOR  SAVING  DROWNING  PERSONS 
BY  SWIMMING  TO  THEIR  RELIEF 


AND  FOR  THE 


TREATMENT    OF    FROSTBITES 

AS  PRACTICED  IN  THE 

UNITED  STATES  COAST  GUARD 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1916 


^$ 


ADDITIONAL  COPIES 

OF  THIS  PUBLICATION  MAY  BE  PROCURED  FROM 

THE   SUPERINTENDENT  OF  DOCUMENTS 

GOVERNMENT  PRINTING  OFFICE 

WASHINGTON,  D.  C. 

AT 

5  CENTS  PER  COPY 


DIRECTIONS  FOR  RESTORING  THE  APPARENTLY  DROWNED. 


Note. — These  directions  differ  from  those  originally  issued  to  the 
Service,  by  the  addition  of  means  for  securing  deeper  inspiration. 
The  method  originally  published,  known  as  the  Howard  or  direct 
method,  has  been  productive  of  excellent  results  in  the  practice  of 
the  Service,  and  is  retained  here.  It  is,  however,  here  arranged  for 
practice  in  combination  with  the  Sylvester  method,  the  latter  produc- 
ing deeper  inspiration  than  any  other  known  method,  while  the 
former  effects  the  most  complete  expiration.  The  combination  there- 
fore tends  to  produce  the  most  rapid  oxygenation  of  the  blood — the 
real  object  to  be  gained.  The  combination  is  prepared  primarily  for 
the  use  of  Coast  Guard  crews  where  assistants  are  at  hand.  A  modi- 
fication of  Rule  III,  however,  is  published  as  a  guide  in  cases  where 
no  assistants  are  at  hand  and  one  person  is  compelled  to  act  alone. 


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F16  I  -  EXPELLING  WATER    FROM    BOOT 

In  preparing  these  directions  the  able  and  exhaustive  report  of  a 
committee  of  the  Humane  Society  of  Massachusetts,  embraced  in  the 
annual  report  of  the  society  for  1895-96,  has  been  availed  of,  placing 
the  Department  under  many  obligations  for  its  valuable  suggestions. 
Rule  I.  Arouse  the  Patient. — Do  not  move  the  patient  unless 
in  danger  of  freezing ;  instantly  expose  the  face  to  the  air,  toward  the 
wind  if  there  be  any ;  wipe  dry  the  mouth  and  nostrils ;  rip  the  cloth- 
ing so  as  to  expose  the  chest  and  waist;  give  two  or  three  quick, 
smarting  slaps  on  the  chest  with  the  open  hand. 

If  the  patient  does  not  revive  proceed  immediately  as  follows : 
Rule  II.  To  Expel  Water  from  the  Stomach  and  Chest  (see 
Fig.  1). — Separate  the  jaws  and  keep  them  apart  by  placing  between 

56315°— 16  3 

345178 


RESTORING    HIE    APPARENTLY    DROWNED. 


the  teeth  a  cork  or  small  bit  of  wood ;  turn  the  patient  on  his  face,  a 
large  bundle  of  tightly  rolled  clothing  being  placed  beneath  the  stom- 
ach ;  press  heavily  on  the  back  over  it  for  half  a  minute,  or  as  long  as 
fluids  flow  freely  from  the  mouth. 

Rule  III.  To  Produce  Breathing  (see  Figs.  2  and  3). — Clear 
the  mouth  and  throat  of  mucus  by  introducing  into  the  throat  the 
corner  of  a  handkerchief  wrapped  closely  around  the  forefinger;  turn 
the  patient  on  the  back,  the  roll  of  clothing  being  so  placed  as  to 
raise  the  pit  of  the  stomach  above  the  level  of  the  rest  of  the  body. 
Let  an  assistant  with  a  handkerchief  or  piece  of  dry  cloth  draw  the 
tip  of  the  tongue  out  of  one  corner  of  the  mouth  (which  prevents  the 
tongue  from  falling  back  and  choking  the  entrance  to  the  windpipe), 
and  keep  it  projecting  a  little  beyond  the  lips.  Let  another  assistant 
grasp  the  arms  just  below  the  elbows  and  draw  them  steadily  upward 
By  the  sides  of  the  patient's  head  to  the  ground,  the  hands  nearly 


FIG.  2-    MOVEMENTS  TO    PRODUCE.    INSPIRATION 


meeting  (which  enlarges  the  capacity  of  the  chest  and  induces  in- 
spiration). (Fig.  2.)  While  this  is  being  done  let  a  third  assistant 
take  position  astride  the  patient's  hips  with  his  elbows  resting  upon 
his  own  knees,  his  hands  extended  ready  for  action.  Next,  let  the 
assistant  standing  at  the  head  turn  down  the  patient's  arms  to  the 
sides  of  the  body,  the  assistant  holding  the  tongue,  changing  hands 
if  necessary1  to  let  the  arms  pass.  Just  before  the  patient's  hands 
reach  the  ground,  the  man  astride  the  body  will  grasp  the  body  with 
his  hands,  the  balls  of  the  thumbs  resting  on  either  side  of  the  pit  of 
the  stomach,  the  fingers  falling  into  the  grooves  between  the  short 
ribs.  Now,  using  his  knees  as  a  pivot,  he  will  at  the  moment  the 
patient's  hands  touch  the  ground  throw  (not  too  suddenly)  all  his 
weight  forward  on  his  hands,  and  at  the  same  time  squeeze  the  waist 
between  them  as  if  he  wished  to  force  anything  in  the  chest  upward 
out  of  the  mouth :  he  will  deepen  the  pressure  while  he  slowly  counts 

1  Changing  hands  will  be  found  unnecessary  after  some  practice  ;  the  tongue,  however, 
must  not  be  released. 


RESTORING    THE    APPARENTLY   DROWNED. 


1,  2,  3,  4  (a  period  of  2  to  2|  seconds)  then  suddenly  let  go  with  a  final 
push,  which  will  spring  him  back  to  his  first  position.1  This  com- 
pletes expiration.     (Fig.  3.) 

At  the  instant  of  his  letting  go,  the  man  at  the  patient's  head  will 
again  draw  the  arms  steadily  upward  to  the  sides  of  the  patient's  head 
as  before  (the  assistant  holding  the  tongue  again  changing  hands  to 
let  the  arms  pass  if  necessary),  holding  them  there  while  he  slowly 
counts  1,  2,  3,  -1  (a  period  of  2  to  2|  seconds).  This  completes  in- 
spiration. 

Repeat  these  movements  deliberately  and  perseveringly  twelve  to 
fifteen  times  in  every  minute — thus  imitating  the  natural  motions  of 
breathing. 

If  natural  breathing  be  not  restored  after  a  trial  of  the  bellows 
movement  for  the  space  of  about  four  minutes,  then  turn  the  patient 
a  second  time  on  the  stomach,  as  directed  in  Rule  II,  rolling  the  body 


FIO>.  3-  MOVEMtNTS    TO   PRODUCE    EXPIRATION 


in  the  opposite  direction  from  that  in  which  it  was  first  turned,  for 
the  purpose  of  freeing  the  air  passage  from  any  remaining  water. 
Continue  the  artificial  respiration  from  one  to  four  hours,  or  until 
the  patient  breathes,  according  to  Rule  III ;  and  for  a  while  after  the 
appearance  of  returning  life,  carefully  aid  the  first  short  gasps  until 
deepened  into  full  breaths.  Continue  the  drying  and  rubbing,  which 
should  have  been  unceasingly  practiced  from  the  beginning  by  as- 
sistants, taking  care  not  to  interfere  with  the  means  employed  to 
produce  breathing.  Thus  the  limbs  of  the  patient  should  be  rubbed, 
always  in  an  upward  direction  toward  the  body,  with  firm-grasping 
pressure  and  energy,  using  the  bare  hands,  dry  flannels  or  handker- 
chiefs, and  continuing  the  friction  under  the  blankets  or  over  the  dry 
clothing.  The  warmth  of  the  body  can  also  be  promoted  by  the 
application  of  hot  flannels  to  the  stomach  and  armpits,  bottles  or 
bladders  of  hot  water,  heated  bricks,  etc.,  to  the  limbs  and  soles  of 
the  feet. 

1  A  child  or  very  delicate  patient  must,  of  course,  be  more  gently  handled. 


6  RESTORING    THE    APPARENTLY    DROWNED. 

Rule  IV.  Affeb-Treatment. — Externally:  As  soon  as  breathing 

is  established  let  the  patient  be  stripped  of  all  wet  clothing,  wrapped 
in  blankets  only,  put  to  bed  comfortably  warm,  but  with  a  free  cir- 
culation of  fresh  air,  and  left  to  perfect  rest.  Internally :  Give 
aromatic  spirits  of  ammonia  in  doses  of  a  teaspoonful  to  a  table- 
spoonful,  according  to  the  weight  of  the  patient,  or  hot  tea  or  coffee, 
every  10  or  15  minutes  for  the  first  hour,  and  as  often  thereafter 
as  may  seem  expedient.  Later  manifestations:  After  reaction  is 
fully  established  there  is  great  danger  of  congestion  of  the  lungs, 
and  if  perfect  rest  is  not  maintained  for  at  least  forty -eight  hours  it 
sometimes  occurs  that  the  patient  is  seized  with  great  difficulty  of 
breathing,  and  death  is  liable  to  follow  unless  immediate  relief  is 
afforded.  In  such  cases  apply  a  large  mustard  plaster  over  the  breast. 
If  the  patient  gasps  for  breath  before  the  mustard  takes  effect,  assist 
the  breathing  by  carefully  repeating  the  artificial   respiration. 


HG.  *-   MOVEMENTS     Br    ONE  PERSON   TO     PRODUCE    INSPIRATION 

Modification  of  Eule  III. 

[To  be  used  after  Rules  I  and  II  in  case  no  assistance  is  at  hand.] 

To  Produce  Respiration. — If  no  assistance  is  at  hand  and  one  per- 
son must  work  alone,  turn  the  patient  on  the  back,  the  roll  of  clothing 
being  so  placed  as  to  raise  the  pit  of  the  stomach  above  the  level  of 
the  rest  of  the  body:  draw  forward  the  tongue  and  keep  it  projecting 
just  beyond  the  lips;  if  the  lower  jaw  be  lifted  the  teeth  may  be  made 
to  hold  the  tongue  in  place ;  it  may  be  necessary  to  retain  the  tongue 
by  passing  a  handkerchief  under  the  chin  and  tying  it  over  the  head. 

Take  position  astride  the  patient's  hips,  as  in  Figure  5.  Grasp  the 
arms  just  below  the  elbows  and  raise  them  steadily  upward  by  the 
sides  of  the  patient's  head  to  the  ground,  the  hands  nearly  meet- 
ing, holding  them  there  while  slowly  counting  1,  2,  3,  4  (a  period  of 
2  to  2£  seconds).  This  enlarges  the  capacity  of  the  chest  and  induces 
inspiration.     (Fig.  4.) 


RESTORING    THE    APPARENTLY   DROWNED.  7 

Next  lower  the  arms  to  the  sides  and  just  before  they  reach  the 
ground  drop  them  and  instantly  grasp  the  body  with  the  hands,  the 
balls  of  the  thumbs  resting  on  either  side  of  the  pit  of  the  stomach, 
the  fingers  falling  into  the  grooves  between  the  short  ribs ;  now,  using 
his  knees  as  a  pivot,  the  operator  will  throw  (not  too  suddenly)  all 
his  weight  forward  on  his  hands,  and  at  the  same  time  squeeze  the 
waist  between  them  as  if  he  wished  to  force  anything  in  the  chest 
upward  out  of  the  mouth :  he  will  deepen  the  pressure  while  he  slowly 
counts  1,  2,  3,  4  (a  period  of  2  to  2^  seconds),  then  suddenly  let  go 


FIG  5-    MOVEMENTS    BY  ONE    PERSON   TO    PRODUCE  EXPIRATION 


with  a  final  push,  which  will  spring  him  back  to  his  first  position  as 
in  rule  3.    This  completes  expiration.     (Fig.  5.) 

At  the  instant  of  letting  go.  grasp  .the  arms  just  below  the  elbows 
and  raise  them  steadily  upward  by  the  sides  of  the  patient's  head  to 
the  ground,  holding  them  there  while  slowly  counting  1,  2.  3,  4  (a 
period  of  2  to  2£  seconds).    This  completes  inspiration.     (Fig.  4.) 

Repeat  these  movements  12  to  15  times  in  every  minute — thus 
imitating  the  natural  motions  of  breathing. 


INSTRUCTIONS  FOR  SAVING  DROWNING  PERSONS  BY  SWIMMING 
TO  THEIR  RELIEF. 


1.  When  you  approach  a  person  drowning  in  the  water  assure  him 
with  a  loud  and  firm  voice  that  he  is  safe. 

2.  Before  jumping  in  to  save  him,  divest  yourself  as  far  and  as 
quickly  as  possible  of  all  clothes;  tear  them  off  if  necessary;  but  if 
there  is  not  time,  loose  at  all  events  the  foot  of  your  drawers,  if  they 
are  tied,  as,  if  you  do  not  do  so,  they  fill  with  water  and  drag  you. 

3.  On  swimming  to  a  person  in  the  sea,  if  he  be  struggling  do  not 
seize  him  then,  but  keep  off  for  a  few  seconds  till  he  gets  quiet,  for  it 
is  sheer  madness  to  take  hold  of  a  man  when  he  is  struggling  in  the 
water,  and  if  you  do  you  run  a  great  risk. 

4.  Then  get  close  to  him  and  take  fast  hold  of  the  hair  of  his  head, 
turn  him  as  quickly  as  possible  onto  his  back,  give  him  a  sudden  pull, 
which  will  cause  him  to  float,  then  throw  yourself  on  your  back  also 
and  swim  for  the  shore,  both  hands  having  hold  of  his  hair,  you  on 
your  back  and  he  also  on  his,  and  of  course  his  back  to  your  stomach. 
In  this  way  you  will  get  sooner  and  safer  ashore  than  by  any  other 
means,  and  you  can  easily  thus  swim  with  two  or  three  persons;  the 
writer  has  even,  as  an  experiment,  done  it  with  four,  and  gone  with 
them  40  or  50  yards  in  the  sea.  One  great  advantage  of  this  method  is 
that  it  enables  you  to  keep  your  head  up  and  also  to  hold  the  person's 
head  up  you  are  trying  to  save.  It  is  of  primary  importance  that  you 
take  fast  hold  of  the  hair  and  throw  both  the  person  and  yourself  on 
your  backs.  After  many  experiments,  it  is  usually  found  preferable 
to  all  other  methods.  You  can  in  this  manner  float  nearly  as  long  as 
you  please,  or  until  a  boat  or  other  help  can  be  obtained. 

5.  It  is  believed  there  is  no  such  thing  as  a  death  grasp;  at  least  it 
is  very  unusual  to  witness  it.  As  soon  as  a  drowning  man  begins  to 
get  feeble  and  to  lose  his  recollection,  he  gradually  slackens  his  hold 
until  he  quits  it  altogether.  Xo  apprehension  need,  therefore,  be  felt 
on  that  head  when  attempting  to  rescue  a  drowning  person. 

6.  After  a  person  has  sunk  to  the  bottom,  if  the  water  be  smooth, 
the  exact  position  where  the  body  lies  may  be  known  by  the  air 
bubbles,  which  will  occasionally  rise  to  the  surface,  allowance  being 
of  course  made  for  the  motion  of  the  water,  if  in  a  tideway  or 
stream,  which  will  have  carried  the  bubbles  out  of  a  perpendicular 
course  in  rising  to  the  surface.  Oftentimes  a  body  may  be  regained 
from  the  bottom,  before  too  late  for  recovery,  by  diving  for  it  in  the 
direction  indicated  by  these  bubbles. 

7.  On  rescuing  a  person  by  diving  to  the  bottom,  the  hair  of  the 
head  should  be  seized  by  one  hand  only,  and  the  other  used  in  con- 
junction with  the  feet  in  raising  yourself  and  the  drowning  person  to 
the  surface. 


10  RESTORING    THE    APPARENTLY    DROWNED. 

8.  If  in  the  sea,  it  may  sometimes  be  a  great  error  to  try  to  get  to 
land.  If  there  be  a  strong  "  outsetting  "  tide,  and  you  are  swimming 
either  by  yourself  or  having  hold  of  a  person  who  can  not  swim,  then 
get  on  your  back  and  float  till  help  comes.  Many  a  man  exhausts 
himself  by  stemming  the  billows  for  the  shore  on  a  back-going  tide, 
and  sinks  in  the  effort,  when,  if  he  had  floated,  a  boat  or  other  aid 
might  have  been  obtained. 

9.  These  instructions  apply  alike  to  all  circumstances,  whether  as 
regards  roucrh  sea  or  smooth  water. 


TREATMENT  OF  FROSTBITES. 


1.  Do  not  bring  the  patient  to  the  fire,  nor  bathe  the  parts  in  warm 
water. 

2.  If  snow  be  on  the  ground,  or  accessible,  take  a  woolen  cloth  in  the 
hand,  place  a  handful  of  snow  upon  it,  and  gently  rub  the  frozen  part 
until  the  natural  color  is  restored.  In  case  snow  is  not  at  hand,  bathe 
the  part  gently  with  a  woolen  cloth  in  the  coldest  fresh  water  obtain- 
able— ice  water,  if  practicable. 

3.  In  case  the  frostbite  is  old,  and  the  skin  has  turned  black  or 
begun  to  scale  off,  do  not  attempt  to  restore  its  vitality  by  friction, 
but  apply  boracic  acid  ointment  on  a  little  cotton;  after  which  wrap 
the  part  loosely  in  flannel. 

4.  In  all  cases,  as  soon  as  the  vitality  has  been  restored,  apply  the 
boracic  acid  ointment,  prepared  according  to  the  following  formula: 

Boracic  acid  ointment — 
Boracic  acid,  1  part. 
Vaseline,  9  parts. 
Mix. 

5.  In  the  case  of  a  person  apparently  dead  from  exposure  to  cold, 
friction  should  be  applied  to  the  body  and  the  lower  extremities,  and 
artificial  respiration  practiced  as  in  cases  of  the  apparently  drowned. 
As  soon  as  the  circulation  appears  to  be  restored,  administer  aromatic 
spirits  of  ammonia  or  hot  tea  or  coffee  at  intervals  of  fifteen  or 
twenty  minutes  until  the  flesh  feels  natural.  Even  if  no  signs  of  life 
appear,  friction  should  be  kept  up  for  a  long  period,  as  instances  are 
on  record  of  recovery  after  several  hours  of  suspended  animation. 

11 

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AN  WBui  ™«iS2 

W1Ul_  INCREASE  TO  50CENTHe    ^^^     DAY 

DAY     AND    TO     $ 

OVERDUE. 


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